Abstract: Malnutrition is aleading cause of child mortality in India. To counteract this problem, anutrition
supplementation programme has been operating under the Integrated Child Development Service (ICDS)
scheme in India since 1975. Recently, the Composite Index of Anthropometric Failure (CIAF) has been
implemented to measure the seriousness and severity of overall under-nutrition in apopulation. Since this
index presents amore complete picture than the previous three conventional measures. CIAF is utililized
in this study which focuses on the overall burden of under-nutrition determination in pre-school children
in Purba Medinipur, West Bengal, India. Our study was conducted in 10 Integrated Child Development
Service (ICDS) centres, commonly known as Anganwadi, in the villages of the Argoal Gram Panchayat
at Patashpur II block. The total sample of 225 Bengalee ethnic children aged between 3 and 6 years was
composed of 115 girls and 110 boys. The overall age and gender-combined prevalence of stunting, underweight and wasting recorded was 30.7%, 42.7% and 12.0%, respectively, and these rates were considered
high (3039%), very high ( 40%) and high (1014%), respectively. CIAF results revealed the same trend,
with 50.2% of these children affected by anthropometric failure, with the prevalence of underweight, wasting and CIAF higher in boys than in girls. This 50.2% CIAF result highlighted that approximately half the
study children were undernourished. Since this figure is much higher than that estimated by any of the
three conventional indicators,, CIAF has thus proven afar better indicator in assessing the overall burden
of under-nutrition in a population. The nutritional status of the children in this study requires serious
remedial action.
Key words: under-nutrition, Composite Index of Anthropometric Failure, rural pre-school children, India
Introduction
Each countrys developmental status is
increasingly judged world-wide on the
nutritional status of its people; and the
Original Article: Received June 11, 2013; Accepted for publication September 22, 2013
DOI: 10.2478/anre-2013-0005
2013 Polish Anthropological Society
110
111
112
Z-score =
X Median of NCHS
Results
Table 2 presents mean, standard deviation (SD) and Z-scores for height-forage (HAZ), weight-for-age (WAZ) and
weight-for-height (WHZ). The overall gender-combined mean (SD) HAZ,
WAZ and WHZ were 1.53 (1.16), 1.79
(0.88) and 1.15 (0.87), respectively.
Table 3 shows the CIAF sub-groups
of undernourished children; with 20.5%
having single anthropometric failure
(Groups B, F and Y) and 29.8% having
multiple anthropometric failure (Groups
C, D and E). After summation in Groups
B-Y we found 50.2% of the children had
ahigh prevalence of under-nutrition with
Description
No failure
Wasting only
Wasting and underweight
Wasting, underweight and stunting
Stunting and underweight
Stunting only
Underweight only
Stunting
No
No
No
Yes
Yes
Yes
No
Underweight
No
No
Yes
Yes
Yes
No
Yes
Wasting
No
Yes
Yes
Yes
No
No
No
113
Table 2. Mean and Standard Deviation WAZ, HAZ and WHZ Gender Scores
HAZ
1.54 (1.03)*
1.42 (1.13)
1.53 (1.16)
Boys (n=110)
Girls (n=115)
Combined (n=225)
WAZ
1.80 (0.85)
1.78 (0.95)
1.79 (0.88)
WHZ
1.19 (0.80)
1.21 (0.74)
1.15 (0.87)
Categories
A. Normal (No Failure)
B. Wasting Only
C. Wasting and Underweight
D. Wasting, Stunting and Underweight
E. Stunting and Underweight
F. Stunting Only
Y. Underweight Only
Total CIAF (B+C+D+E+F+Y)
Girls
(n=115)
60 (26.7)
0 (0.0)
3 (1.3)
10 (4.4)
18 (8.0)
8 (3.5)
16 (7.1)
55 (24.4)
Combined
(n=225)
112 (49.8)
2 (0.9)
13 (5.8)
12 (5.3)
42 (18.7)
15 (6.7)
29 (12.9)
113 (50.2)
*Percentages are presented in parentheses and calculated on the total sample number; N=225.
80
70
60
50
40
30
20
10
0
52.7 50.2
47.8
44.5 42.7
40.9
30
and high (1014%), respectively, according to WHO (1995) classification of under-nutrition severity. The CIAF followed
this trend with 50.2% children CIAF affected. Although the boys prevalence
of underweight, wasting and CIAF was
higher than girls, and girls had a greater prevalence of stunting, there were no
significant gender differences recorded in
the studied children; stunting (2=2.48,
31.3
30.7
Underweight
Wasting
CIAF
IC
Stunting
D
S
Ar ch
am ild
ba ren
gh ,
Tr
ib
al
c
Ba hild
nk ren
ur ,
a
C
Ta h
m ild
ilN re
ad n,
Ba
u
ru
ic
h
Ba ild
nk ren
ur ,
IC
a
D
S
ch
Pu ildr
rb en
a. ,
..
12.7
12
11.3
Boys
Girls
Sex Combined
Fig. 1. Under-nutrition prevalence (%) using different indicators in the studied children
CIAF
114
Discussion
Stunting, underweight and wasting are
used as anthropometric indicators of under-nutrition in children. However, individually these three indicators can not
adequately express the overall number or
prevalence of undernourished children
in a population, and they tend to conceal rather than reveal the real problem
faced by a nation. Therefore, the newly
constructed CIAF indicator is a current
improvement in evaluating childhood
population nutritional status.
The mean HAZ, WAZ and WHZ in
this study had negative values. For WAZ
this was approximately 2.0 (boys=1.80;
girls=1.78), and WHZ values were generally lower than HAZ and WAZ, thus
indicating poor current nutritional status. In contrast to WHZ, WAZ indicates
current nutritional condition as opposed
to low HAZ which indicates chronic nutritional stress). Overall figures revealed
that 30.7% of the study children suffered
from stunted growth, 42.7% were underweight and 12.0% were in awasted condition. These figures were quite similar
to the regional figures for West Bengal,
where the overall prevalence of stunting,
underweight and wasting were 38.7%
45.5% 13.5%, respectively. The overall
prevalence of stunting, underweight and
Girls
(N=115)
31.3
40.9
11.3
47.8
Combined
(N=225)
30.7
42.7
12.0
50.2
115
References
Bamji MS. 2003. Early nutrition and health:
Indian perspective. Current Science
85:113742.
Bharati S, Pal M, Bharati P. 2008. Determinants of Nutritional Status of Pre-school
Children in India. J Biosoc Sci 40(6):80114.
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